tizanidine vs. diazepam

Nancie · 01-08-2009, 08:02 PM

i think the name-brands of these drugs are zanaflex and valium.
does one work better than the other for spasm control? i'm a long time (30yrs post) sci-er and have always taken valium just because that's what they prescribed way-back-when.
if zanaflex seems to work better, i'd certainly give it a try.
thanks.

kkmay · 01-08-2009, 08:14 PM

I take both of them. Although I'd rather get off of diazepam since it is no longer covered under insurance. However when I tried, it did a number on my brain. I was almost comatose.

tinern · 01-08-2009, 08:40 PM

I take Zanaflex for muscle spasms and occasionally use Valium at night time to help with leg spasms and problems sleeping. Good luck, finding the right anti-spasmodic is an easy.

SCI-Nurse · 01-09-2009, 03:21 PM

Hi,

There are several antispasmodics. In my practice, the most popular is to start with baclofen and if not effective then tizanidine is added. You are right that valium was
used more in teh past and many people get great relief from this, but newer meds with supposed less side effects and potential for abuse seem to be used more currently.

It's a matter or trial and error. What you really want to avoid is being on many different agents at one time. While some people are hesitant, I try to work with the people to get them off multiple drugs and have higher effective doses of 1 or 2 if necessary. Side effects and interactions seem to be less.

AAD

Wise Young · 01-09-2009, 03:54 PM

Let me add another perspective from the viewpoint of mechanisms. When you mix drugs, it is useful to know the mechanisms by which the drugs act, whether they are pushing the same buttons or different buttons on the neurons.

Baclofen is what is called a GABA-B receptor agonist. In other words, it turns on GABA-B receptors. GABA and glycine are the two major inhibitory neurotransmitters of the central nervous system. GABA plays a more important role in motor systems and particularly in the spinal cord. GABA presses two buttons (receptors) on neurons: the GABA-A and GABA-B receptors. GABA-A turns on chloride channels that makes the membrane more negative and reduces the excitability of neurons. GABA-B turns on intracellular messengers that tell the neurons to activate cellular programs that reduce their excitability.

Diazepam is a GABA receptor enhancer. In other words, it enhances the effects of GABA. It is called a tranquilizer because it calms people down by reducing neuronal excitability. It is also a "muscle relaxant" because it reduces the excitability of spinal reflexes. The problem is that diazepam has effects on the brain. Two of its most important side effects are short-term memory loss and sleepiness. It is also addictive in the sense that the brain becomes dependent on it and sudden withdrawal of the drug may result in unpleasant hyperexcitability states.

Tizanidine is an alpha-2 adrenergic receptor agonist. It reduces excitatory amino acid release by spinal interneurons. It also seems to have an anti-nociceptive (anti-pain) and anti-convulsant (anti-seizure) activity. It has relatively mild or transient cardiovascular side-effects. While high doses may depress the central nervous system, there is sufficient separation of its CNS depressive effects and its anti-spasticity activity so that this is not usually a problem. Its main side effects are dry mouth, flushing, tiredness, and weakness.

Dantrolene is a muscle relaxant that acts directly on the excitation-contraction coupling in muscle cells, through the ryanodine receptor. It is the specific and high effective treatment of a condition called malignant hyperthermia (which results from overactivity of muscle) and neuroleptic malignant syndrome (which also causes overactivity of muscle) that may occur with a variety of drug (or anesthesia) overdose and intoxication. Before baclofen, dantolene was the most popular anti-spasticity drug. Today, it is rarely prescribed alone for spasticity because its main side-effect is muscle weakness. Dantrolene should not be used in people who have pre-existing liver disease, compromised lung function, severe cardiovascular impairment, or weak muscles whose function is crucial for activity of daily living.

Thus, when you take diazepam along with baclofen, both drugs press the same GABA button, enhancing each other's side-effects. Tizanidine acts on a different mechanism, directly affecting spasticity by reducing glutamate neurotransmitter release and excitability of spinal circuits. Dantrolene reduces spasticity by inhibiting muscle, which is not desirable particularly in people cervical spinal cord injury with compromised lung function and weak hand muscles but it might be useful for people with paraplegia for whom baclofen plus tizanidine are insufficient to control spasticity.

Wise.

SCI-Nurse · 01-09-2009, 04:30 PM

Great points, thanks Wise.

AAD

summergirl89 · 01-09-2009, 04:48 PM

are there any anti-spasm meds that do not cause drowsiness? i have never been on any meds for this b/c i have always assumed they would make me drowsy and i work full time, drive, live alone etc. and being a c7 quad balance at certain times is hard enough. plus, i wouldn't want to drive either. however, sometimes my spasms-although still mostly manageable have gotten worse in the last year or so-at times when transferring my stomach will spasm, throwing me backwards-sometimes i can feel it coming so i can brace myself but twice i was transferring onto my shower chair and it threw me backwards and i landed from my back up to my head on the side of the tub. luckily both times i was about to get my arm around some aluminum on my shower chair and pull myself up but sure would be nice if there was something out there that could make it easier because one day im not going to land on the side of the tub...im going to go on back to the floor, im sure and that wont be good!

01-08-2009, 08:02 PM	#1
Nancie Senior Member Join Date: Oct 2002 Location: NY Posts: 247	tizanidine vs. diazepam i think the name-brands of these drugs are zanaflex and valium. does one work better than the other for spasm control? i'm a long time (30yrs post) sci-er and have always taken valium just because that's what they prescribed way-back-when. if zanaflex seems to work better, i'd certainly give it a try. thanks.

01-08-2009, 08:14 PM	#2
kkmay Senior Member Join Date: Sep 2005 Location: In your nightmares Posts: 1,525	I take both of them. Although I'd rather get off of diazepam since it is no longer covered under insurance. However when I tried, it did a number on my brain. I was almost comatose. __________________ Wonderful, more snow on the way...

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01-08-2009, 08:40 PM	#3
tinern Senior Member Join Date: Aug 2001 Location: PA Posts: 137	I take Zanaflex for muscle spasms and occasionally use Valium at night time to help with leg spasms and problems sleeping. Good luck, finding the right anti-spasmodic is an easy.

01-09-2009, 03:21 PM	#4
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 30,233	Hi, There are several antispasmodics. In my practice, the most popular is to start with baclofen and if not effective then tizanidine is added. You are right that valium was used more in teh past and many people get great relief from this, but newer meds with supposed less side effects and potential for abuse seem to be used more currently. It's a matter or trial and error. What you really want to avoid is being on many different agents at one time. While some people are hesitant, I try to work with the people to get them off multiple drugs and have higher effective doses of 1 or 2 if necessary. Side effects and interactions seem to be less. AAD

01-09-2009, 03:54 PM	#5
Wise Young Administrator Join Date: Jul 2001 Location: New Brunswick, NJ, USA Posts: 34,572	Let me add another perspective from the viewpoint of mechanisms. When you mix drugs, it is useful to know the mechanisms by which the drugs act, whether they are pushing the same buttons or different buttons on the neurons. Baclofen is what is called a GABA-B receptor agonist. In other words, it turns on GABA-B receptors. GABA and glycine are the two major inhibitory neurotransmitters of the central nervous system. GABA plays a more important role in motor systems and particularly in the spinal cord. GABA presses two buttons (receptors) on neurons: the GABA-A and GABA-B receptors. GABA-A turns on chloride channels that makes the membrane more negative and reduces the excitability of neurons. GABA-B turns on intracellular messengers that tell the neurons to activate cellular programs that reduce their excitability. Diazepam is a GABA receptor enhancer. In other words, it enhances the effects of GABA. It is called a tranquilizer because it calms people down by reducing neuronal excitability. It is also a "muscle relaxant" because it reduces the excitability of spinal reflexes. The problem is that diazepam has effects on the brain. Two of its most important side effects are short-term memory loss and sleepiness. It is also addictive in the sense that the brain becomes dependent on it and sudden withdrawal of the drug may result in unpleasant hyperexcitability states. Tizanidine is an alpha-2 adrenergic receptor agonist. It reduces excitatory amino acid release by spinal interneurons. It also seems to have an anti-nociceptive (anti-pain) and anti-convulsant (anti-seizure) activity. It has relatively mild or transient cardiovascular side-effects. While high doses may depress the central nervous system, there is sufficient separation of its CNS depressive effects and its anti-spasticity activity so that this is not usually a problem. Its main side effects are dry mouth, flushing, tiredness, and weakness. Dantrolene is a muscle relaxant that acts directly on the excitation-contraction coupling in muscle cells, through the ryanodine receptor. It is the specific and high effective treatment of a condition called malignant hyperthermia (which results from overactivity of muscle) and neuroleptic malignant syndrome (which also causes overactivity of muscle) that may occur with a variety of drug (or anesthesia) overdose and intoxication. Before baclofen, dantolene was the most popular anti-spasticity drug. Today, it is rarely prescribed alone for spasticity because its main side-effect is muscle weakness. Dantrolene should not be used in people who have pre-existing liver disease, compromised lung function, severe cardiovascular impairment, or weak muscles whose function is crucial for activity of daily living. Thus, when you take diazepam along with baclofen, both drugs press the same GABA button, enhancing each other's side-effects. Tizanidine acts on a different mechanism, directly affecting spasticity by reducing glutamate neurotransmitter release and excitability of spinal circuits. Dantrolene reduces spasticity by inhibiting muscle, which is not desirable particularly in people cervical spinal cord injury with compromised lung function and weak hand muscles but it might be useful for people with paraplegia for whom baclofen plus tizanidine are insufficient to control spasticity. Wise.

01-09-2009, 04:30 PM	#6
SCI-Nurse Moderator Join Date: Jul 2001 Location: USA Posts: 30,233	Great points, thanks Wise. AAD

01-09-2009, 04:48 PM	#7
summergirl89 Senior Member Join Date: Aug 2008 Location: South Carolina Posts: 110	are there any anti-spasm meds that do not cause drowsiness? i have never been on any meds for this b/c i have always assumed they would make me drowsy and i work full time, drive, live alone etc. and being a c7 quad balance at certain times is hard enough. plus, i wouldn't want to drive either. however, sometimes my spasms-although still mostly manageable have gotten worse in the last year or so-at times when transferring my stomach will spasm, throwing me backwards-sometimes i can feel it coming so i can brace myself but twice i was transferring onto my shower chair and it threw me backwards and i landed from my back up to my head on the side of the tub. luckily both times i was about to get my arm around some aluminum on my shower chair and pull myself up but sure would be nice if there was something out there that could make it easier because one day im not going to land on the side of the tub...im going to go on back to the floor, im sure and that wont be good!